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General NPI Number Information
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NPI Number | 1366992976
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Entity Type | Organization
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Legal Business Name | TOTAL BODY CHIROPRACTIC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 2201 MIDWAY RD STE 107
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City | CARROLLTON
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State | TX
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Zip | 75006
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Country | US
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Telephone | 972-891-5092
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261
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City | COPPELL
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State | TX
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Zip | 75019-0261
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTOR
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Name | STEPHAN CONLEY
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Credential | D.C.
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Telephone | 972-891-5092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13111
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License Number State | TX
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